Hemodynamics and Cerebral Oxygenation Following Repair of Tetralogy of Fallot: The Effects of Converting From Positive Pressure Ventilation to Spontaneous Breathing

Bronicki, Ronald A.; Herrera, Marilyn; Mink, Richard; Domico, Michele; Tucker, Dawn; Chang, Anthony; Anas, Nick

doi:10.1111/j.1747-0803.2010.00445.x

Cited by 31 publications

(13 citation statements)

References 24 publications

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“…It has been proposed that cardiac output in patients after TOF repair can be augmented by conversion of positive pressure ventilation to either negative pressure ventilation or spontaneous breathing [1,2,17]. The diastolic pulmonary arterial flow is sensitive to changes in intrathoracic pressure.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Hemodynamic Effects of Extubation Failure in Children Undergoing Complete Repair for Tetralogy of Fallot

Dodgen

Swearingen

et al. 2013

Pediatr Cardiol

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This study aimed to identify the prevalence, etiology, and outcomes of extubation failure in children after complete repair for tetralogy of Fallot at a single tertiary-care, academic children's hospital. The secondary aim of this study was to determine the cardiorespiratory effects of the transition from positive-pressure ventilation to spontaneous breathing in children with extubation success and extubation failure. For this study, extubation was defined as the need for reintubation within 96 h after extubation. Demographics as well as pre-, intra-, post-, and periextubation data were collected in a retrospective observational format for patients who underwent complete repair for tetralogy of Fallot during the period January 2001-June 2011. Patients with multiple aortopulmonary collateral arteries or associated complete atrioventricular septal defects were excluded from the study. The cardiorespiratory variables collected before and immediately after extubation included heart rate, respiratory rate, mean arterial blood pressure, central venous pressures, near-infrared spectroscopy, oxygen saturations, and lactate levels. The clinical outcomes evaluated included the success or failure of extubation and the hospital length of stay. Descriptive and univariate statistics were used to compare the group with extubation failure and the group with extubation success. Extubation failure occurred for 7 % (12/164) of the 164 eligible patients during the study period. The median age of the patients at surgery was 200 days (range 98-356 days), and their median weight was 6.8 kg (range 5.2-8.5 kg). For 6 % (10/164) of the patients, intubation was performed before surgery. The median duration of mechanical ventilation was 33 h (range 19.5-73 h), and the median hospital stay was 10 days (range 7-15 days). Of the 12 patients with extubation failure, 2 had extubation failure in first 2 h after extubation, 6 had failure in 2-24 h, 3 had failure in 24-48 h, and 1 had failure in 48-96 h. The patients in the extubation success and extubation failure groups were similar in age, sex, and body weight at the time of surgery. All preexisting conditions also were similar in the two groups. The intraoperative variables and postoperative complications did not differ between the two groups. The hospital stay was longer for the children with extubation failure (p < 0.001). The partial pressure of oxygen in arterial blood (PaO2), tachycardia, mean arterial blood pressure, and inotrope score improved significantly at conversion from positive-pressure ventilation to spontaneous ventilation in the patients with extubation success. This study demonstrated that extubation failure in patients after complete repair for tetralogy of Fallot is low and that the etiology is diverse. The majority of extubation failures in these patients occurred in the first 24 h. Extubation success in the children after repair for tetralogy of Fallot was associated with improvement in PaO2, tachycardia, and mean arterial pressure, with a decrease in inotrope score. Extub...

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Section: Discussionmentioning

confidence: 99%

Characteristics and Hemodynamic Effects of Extubation Failure in Children Undergoing Complete Repair for Tetralogy of Fallot

Dodgen

Swearingen

et al. 2013

Pediatr Cardiol

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“…Since diaphragmatic descent increases intra-abdominal pressure, these combined effects cause decreased right atrial pressure and increased venous pressure in the abdomen, markedly increasing the pressure gradient for systemic venous return [23]. Furthermore, the greater the decrease in ITP, the greater the increase in LV afterload for a constant arterial pressure, and right ventricle stroke output increases [24]. Pulmonary edema from negative pressure effect in patient breathing through the narrow endotracheal tube could also contribute to lower ITP.…”

Section: Physiology Of Spontaneous Breathing Trialsmentioning

confidence: 99%

Failed Weaning from Mechanical Ventilation and Cardiac Dysfunction

Porhomayon

Papadakos

Nader

2012

Critical Care Research and Practice

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Failure to transition patient from controlled mechanical ventilation to spontaneous breathing trials (SBTs) in a timely fashion is associated with significant morbidity and mortality in the intensive care unit. In addition, weaning failures are common in patients with limited cardiac reserves. Recent advances in cardiac echocardiography and laboratory measurement of serum biomarkers to assess hemodynamic response to SBT may provide additional information to guide clinicians to predict weaning outcome.

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“…Some studies found that negative pressure ventilation following corrective surgery of TOF was associated with improved blood pressure [4,5]. In the present study, PEEP was set at between 2 and 8 cmH 2 O, and the tidal volume between 8 and 10 mL/kg during preoperational ventilation therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative negative-pressure ventilation improved the stroke volume and cardiac output by more than 45%, and reduced the systemic and pulmonary vascular resistances [4]. Converting from positive pressure ventilation to spontaneous negative pressure breathing following repair of TOF also improved arterial blood pressure and cerebral oxygenation [5]. There has been little information on the relations between preoperational mechanical ventilation and the postoperative outcomes of TOF repair.…”

Section: T Etralogy Of Fallot (Tof) Is a Common Cyanotic Congen-mentioning

confidence: 99%

Effect of Preoperational Mechanical Ventilation on Short-Term Postoperative Outcomes in Patients with Severe Tetralogy of Fallot

Dong

Wang

et al. 2012

Heart, Lung and Circulation

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Hemodynamics and Cerebral Oxygenation Following Repair of Tetralogy of Fallot: The Effects of Converting From Positive Pressure Ventilation to Spontaneous Breathing

Abstract: We conclude that converting from positive pressure ventilation to spontaneous negative pressure breathing following repair of TOF significantly improves arterial blood pressure and cerebral oxygenation.

Cited by 31 publications

References 24 publications

Characteristics and Hemodynamic Effects of Extubation Failure in Children Undergoing Complete Repair for Tetralogy of Fallot

Characteristics and Hemodynamic Effects of Extubation Failure in Children Undergoing Complete Repair for Tetralogy of Fallot

Failed Weaning from Mechanical Ventilation and Cardiac Dysfunction

Effect of Preoperational Mechanical Ventilation on Short-Term Postoperative Outcomes in Patients with Severe Tetralogy of Fallot

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